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1.
BMC Health Serv Res ; 22(1): 759, 2022 Jun 08.
Article in English | MEDLINE | ID: covidwho-1883526

ABSTRACT

BACKGROUND: COVID-19 catalyzed a rapid and substantial reorganization of primary care, accelerating the spread of existing strategies and fostering a proliferation of innovations. Access to primary care is an essential component of a healthcare system, particularly during a pandemic. We describe organizational innovations aiming to improve access to primary care and related contextual changes during the first 18 months of the COVID-19 pandemic in two Canadian provinces, Quebec and Nova Scotia. METHODS: We conducted a multiple case study based on 63 semi-structured interviews (n = 33 in Quebec, n = 30 in Nova Scotia) conducted between October 2020 and May 2021 and 71 documents from both jurisdictions. We recruited a diverse range of provincial and regional stakeholders (e.g., policy-makers, decision-makers, family physicians, nurses) involved in reorganizing primary care during the COVID-19 pandemic using purposeful sampling (e.g., based on role, region). Interviews were transcribed verbatim and thematic analysis was conducted in NVivo12. Emerging results were discussed by team members to identify salient themes and organized into logic models. RESULTS: We identified and analyzed six organizational innovations. Four of these - centralized public online booking systems, centralized access centers for unattached patients, interim primary care clinics for unattached patients, and a community connector to health and social services for older adults - pre-dated COVID-19 but were accelerated by the pandemic context. The remaining two innovations were created to specifically address pandemic-related needs: COVID-19 hotlines and COVID-dedicated primary healthcare clinics. Innovation spread and proliferation was influenced by several factors, such as a strengthened sense of community amongst providers, decreased patient demand at the beginning of the first wave, renewed policy and provider interest in population-wide access (versus attachment of patients only), suspended performance targets (e.g., continuity ≥80%) in Quebec, modality of care delivery, modified fee codes, and greater regional flexibility to implement tailored innovations. CONCLUSION: COVID-19 accelerated the uptake and creation of organizational innovations to potentially improve access to primary healthcare, removing, at least temporarily, certain longstanding barriers. Many stakeholders believed this reorganization would have positive impacts on access to primary care after the pandemic. Further studies should analyze the effectiveness and sustainability of innovations adapted, developed, and implemented during the COVID-19 pandemic.


Subject(s)
COVID-19 , Aged , COVID-19/epidemiology , Canada , Humans , Nova Scotia/epidemiology , Organizational Innovation , Pandemics , Primary Health Care , Quebec/epidemiology
2.
BMC Public Health ; 22(1): 1032, 2022 May 23.
Article in English | MEDLINE | ID: covidwho-1862120

ABSTRACT

BACKGROUND: Since the beginning of the COVID-19 pandemic, many countries, including Canada, have adopted unprecedented physical distancing measures such as closure of schools and non-essential businesses, and restrictions on gatherings and household visits. We described time trends in social contacts for the pre-pandemic and pandemic periods in Quebec, Canada. METHODS: CONNECT is a population-based study of social contacts conducted shortly before (2018/2019) and during the COVID-19 pandemic (April 2020 - February 2021), using the same methodology for both periods. We recruited participants by random digit dialing and collected data by self-administered web-based questionnaires. Questionnaires documented socio-demographic characteristics and social contacts for two assigned days. A contact was defined as a two-way conversation at a distance ≤ 2 m or as a physical contact, irrespective of masking. We used weighted generalized linear models with a Poisson distribution and robust variance (taking possible overdispersion into account) to compare the mean number of social contacts over time and by socio-demographic characteristics. RESULTS: A total of 1291 and 5516 Quebecers completed the study before and during the pandemic, respectively. Contacts significantly decreased from a mean of 8 contacts/day prior to the pandemic to 3 contacts/day during the spring 2020 lockdown. Contacts remained lower than the pre-COVID period thereafter (lowest = 3 contacts/day during the Christmas 2020/2021 holidays, highest = 5 in September 2020). Contacts at work, during leisure activities/in other locations, and at home with visitors showed the greatest decreases since the beginning of the pandemic. All sociodemographic subgroups showed significant decreases of contacts since the beginning of the pandemic. The mixing matrices illustrated the impact of public health measures (e.g. school closure, gathering restrictions) with fewer contacts between children/teenagers and fewer contacts outside of the three main diagonals of contacts between same-age partners/siblings and between children and their parents. CONCLUSION: Physical distancing measures in Quebec significantly decreased social contacts, which most likely mitigated the spread of COVID-19.


Subject(s)
COVID-19 , Physical Distancing , Adolescent , COVID-19/epidemiology , COVID-19/prevention & control , Child , Communicable Disease Control/methods , Humans , Pandemics/prevention & control , Quebec/epidemiology , Schools
3.
Int J Infect Dis ; 121: 1-10, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1859794

ABSTRACT

BACKGROUND: Epidemics of COVID-19 strained hospital resources. We describe temporal trends in mortality risk and length of stays in hospital and intensive care units (ICUs) among patients with COVID-19 hospitalized through the first three epidemic waves in Canada. METHODS: We used population-based provincial hospitalization data from the epicenters of Canada's epidemics (Ontario and Québec). Adjusted estimates were obtained using marginal standardization of logistic regression models, accounting for patient-level and hospital-level determinants. RESULTS: Using all hospitalizations from Ontario (N = 26,538) and Québec (N = 23,857), we found that unadjusted in-hospital mortality risks peaked at 31% in the first wave and was lowest at the end of the third wave at 6-7%. This general trend remained after adjustments. The odds of in-hospital mortality in the highest patient load quintile were 1.2-fold (95% CI: 1.0-1.4; Ontario) and 1.6-fold (95% CI: 1.3-1.9; Québec) that of the lowest quintile. Mean hospital and ICU length of stays decreased over time but ICU stays were consistently higher in Ontario than Québec. CONCLUSIONS: In-hospital mortality risks and length of ICU stays declined over time despite changing patient demographics. Continuous population-based monitoring of patient outcomes in an evolving epidemic is necessary for health system preparedness and response.


Subject(s)
COVID-19 , Epidemics , Cohort Studies , Hospital Mortality , Hospitalization , Humans , Intensive Care Units , Length of Stay , Ontario/epidemiology , Quebec/epidemiology , Retrospective Studies
4.
Sante Publique ; Vol. 33(6): 991-995, 2022 Mar 11.
Article in French | MEDLINE | ID: covidwho-1818289

ABSTRACT

INTRODUCTION: Facing COVID-19, most of health care system first responded with the confinement of the population and an increase of intensive care resources. Primary care was then mobilized variably and more or less coordinated. PURPOSE OF RESEARCH: Comparing the involvement of primary care in four francophone regions with similar primary care to draw lessons for reforms directions in light of the COVID experience. RESULTS: Mobilization of primary care actors was important, heterogeneous and linked to local context and previous dynamics at the territorial level or the practice level except in Quebec where primary care is governed by health authorities. The creation of COVID centers was systematic as "warm practices" in Quebec or left to the initiative of local stakeholders more or less supported by health authorities. Teleconsultation, largely dominated by the use of the telephone, was implemented everywhere, generally supported by flexible and adapted pricing. The performance of diagnostic tests such as vaccination by new professionals within a legal, financial and simple training framework is a major area for improvement. Information systems to assess local needs were insufficient everywhere. CONCLUSION: The definition of primary care governance methods and, in particular, the link between professionals and public health operators in the four areas studied is a priority area for improvement at both local and national levels.


Subject(s)
COVID-19 , Belgium , COVID-19/epidemiology , France/epidemiology , Humans , Primary Health Care , Quebec/epidemiology , Switzerland
5.
Sante Publique ; Vol. 33(6): 897-904, 2022 Mar 11.
Article in French | MEDLINE | ID: covidwho-1818280

ABSTRACT

INTRODUCTION: Psychosocial impacts of the coronavirus (COVID-19) pandemic, including those on mental health, are now recognized. However, the experience of the COVID-19 pandemic differs from one individual, group or context to another and solutions to cope with it must be adapted and contextualized. AIM OF THE STUDY: This study aims to identify factors of psychosocial vulnerability in rural populations in Quebec (Canada). METHOD: The approach is adapted from previous work on the prevention and reduction of the psychosocial impacts of climate change in non-metropolitan areas. A descriptive qualitative design based on several data sources was used. The data come from a press review, a review of the scientific literature, semi-structured interviews with key actors in the community and municipal domains. RESULTS: Data triangulation and validation by community organization teams (public health department) identified forty-one (N = 41) factors (e.g., social cohesion, digital literacy) likely to increase or decrease the psychosocial vulnerability of rural populations in the context of a pandemic. These factors are grouped under six categories of determinants: 1) population's knowledge and attitudes towards the pandemic, 2) previous experience of difficult events, 3) community dynamism, social cohesion and solidarity, 4) citizens, municipalities and government authorities' involvement, 5) health and social services and those from their intersectoral partners, and 6) land use planning. CONCLUSION: These results are useful for local and regional public health teams in developing local portraits of psychosocial vulnerabilities to support plans to strengthen community resilience and reduce social and health inequalities accentuated by the pandemic.


Subject(s)
COVID-19 , Pandemics , Adaptation, Psychological , COVID-19/epidemiology , Humans , Pandemics/prevention & control , Quebec/epidemiology , Rural Population
6.
Sante Publique ; Vol. 33(6): 853-862, 2022 Mar 11.
Article in French | MEDLINE | ID: covidwho-1818277

ABSTRACT

INTRODUCTION: Retention of healthcare workers (HCWs) in the healthcare system during the COVID-19 pandemic could become a challenge. It is therefore important to better understand what are the motivational elements that could explain a greater or lesser motivation to care for infected patients. OBJECTIVES: To evaluate factors modulating HCWs' willingness to treat COVID-19 infected patients. METHODS: HCWs from Québec, Canada, were invited to complete an online survey during the first wave of the COVID-19 pandemic between the months of April and July 2020. The survey focused on the intention to avoid treating infected patients, prior experiences in treating COVID-19 patients and anxiety levels. Descriptive statistics and multiple regression analysis were used to assess which factors explained differences in HCWs intention to avoid treating patients. RESULTS: A total of 430 HCW completed the survey. A majority were women (87%) and nurses (50%). Of those, 12% indicated having considered measures to avoid working with COVID-19 infected patients and 5% indicated having taken actions to avoid working with infected patients. A further 18% indicated that they would use a hypothetical opportunity to avoid working with infected patients. Having previously treated infected patients was associated with a significant reduction in the intention to avoid work (OR: 0.56 CI 0.36-0.86). Amongst HCWs, physicians had a significantly reduced intention to avoid treating infected patients (OR: 0.47 CI 0.23-0.94). We also found that an increase in anxiety score was associated with a greater intention to avoid treating COVID-19 infected patients (OR: 1.06 CI 1.04-1.08). CONCLUSION: Study results suggest that previous experience in treating COVID-19 infected patients is protective in terms of work-avoidance intentions. We also found that amongst HCWs, physicians had a significantly lower intention to avoid working with COVID-19 infected patients. Finally, our results show that increase in anxiety is associated with a higher intention to avoid treating infected patients. Characterization of factors associated with low anxiety levels and low reluctance to work during the COVID-19 pandemic could be useful in staffing facilities during the present and future healthcare crisis.


Subject(s)
COVID-19 , Influenza, Human , Attitude of Health Personnel , COVID-19/therapy , Female , Health Personnel , Humans , Male , Motivation , Pandemics , Quebec/epidemiology
7.
CMAJ Open ; 10(2): E379-E389, 2022.
Article in English | MEDLINE | ID: covidwho-1798679

ABSTRACT

BACKGROUND: There have been multiple waves in the COVID-19 pandemic in many countries. We sought to compare mortality and respiratory, cardiovascular and renal dysfunction between waves in 3 Canadian provinces. METHODS: We conducted a substudy of the ARBs CORONA I study, a multicentre Canadian pragmatic observational cohort study that examined the association of pre-existing use of angiotensin receptor blockers with outcomes in adults admitted to hospital with acute COVID-19 up to April 2021 from 9 community and teaching hospitals in 3 Canadian provinces (British Columbia, Ontario and Quebec). We excluded emergency department admissions without hospital admission, readmissions and admissions for another reason. We used logistic and 0-1-inflated ß regression models to compare 28-day and in-hospital mortality, and the use of invasive mechanical ventilation, vasopressors and renal replacement therapy (RRT) between the first 3 waves of the COVID-19 pandemic in these provinces. RESULTS: A total of 520, 572 and 245 patients in waves 1, 2 and 3, respectively, were included. Patients in wave 3 were on average younger and had fewer comorbidities than those in waves 1 and 2. The unadjusted 28-day mortality rate was significantly lower in wave 3 (7.8%) than in wave 1 (18.3%) (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.24-0.78) and wave 2 (16.3%) (OR 0.46, 95% CI 0.27-0.79). After adjustment for differences in baseline characteristics, the difference in 28-day mortality remained significant (adjusted OR wave 3 v. wave 1: 0.46, 95% CI 0.26-0.81; wave 3 v. wave 2: 0.52, 95% CI 0.29-0.91). In-hospital mortality findings were similar. Use of invasive mechanical ventilation or vasopressors was less common in waves 2 and 3 than in wave 1, and use of RRT was less common in wave 3 than in wave 1. INTERPRETATION: Severity of illness decreased (lower mortality and less use of organ support) across waves among patients admitted to hospital with acute COVID-19, possibly owing to changes in patient demographic characteristics and management, such as increased use of dexamethasone. Continued application of proven therapies may further improve outcomes. STUDY REGISTRATION: ClinicalTrials.gov, no. NCT04510623.


Subject(s)
COVID-19 , Pandemics , Adult , Angiotensin Receptor Antagonists , Angiotensin-Converting Enzyme Inhibitors , British Columbia , COVID-19/epidemiology , COVID-19/therapy , Cohort Studies , Hospitals , Humans , Multiple Organ Failure , Ontario , Quebec/epidemiology , SARS-CoV-2
8.
Can J Public Health ; 113(3): 394-404, 2022 06.
Article in English | MEDLINE | ID: covidwho-1791624

ABSTRACT

OBJECTIVES: Psychological consequences of COVID-19 contact, symptoms, or diagnosis are being increasingly reported. Few studies have examined the psychological effects tied to these events, using an unaffected comparison group. Most did not consider confounding factors like fear and stigma. This study aims to (1) identify individual characteristics associated with COVID-19 contact/symptoms or diagnosis and (2) examine the independent association between COVID-19 contact/symptoms or diagnosis and psychological symptoms. METHODS: From September 2020 to February 2021, 20,327 adults participated in community-based surveys in Quebec. Using repeated cross-sectional online questionnaire, data were collected on probable generalized anxiety disorder (GAD) and major depression episode (MDE), using the GAD-7 and the PHQ-9 scales, respectively. Self-reported events of (1) contact with a case or symptoms of COVID-19, and (2) diagnosis of COVID-19 were examined, along with several sociodemographic and pandemic-related factors. RESULTS: COVID-19 contact, symptoms, or diagnosis was more frequent in young adults, healthcare or social services workers, adults living with children, and those reporting a greater sense of threat, stigma, financial losses, or daily stress. COVID-19 contact or symptoms and diagnosis were associated with probable MDE relative to the unaffected group (adjusted odds ratio [aOR]: 1.25, 95% CI: 1.12-1.39 and aOR:1.82, 95% CI: 1.48-2.2, respectively). Suicidal thoughts and psychomotor retardation were the symptoms most closely associated with a COVID-19 diagnosis. CONCLUSION: Results from this study stress the need for better understanding, recognition, and support for people suffering from psychological symptoms following a COVID-19 diagnosis.


RéSUMé: OBJECTIFS: Les conséquences psychologiques d'un contact, de symptômes ou d'un diagnostic de COVID-19 sont de plus en plus signalées. Peu d'études ont examiné les effets psychologiques liés à ces évènements en utilisant des groupes non affectés et n'ont pas tenu compte des facteurs de confusion tels que la peur et la stigmatisation. Cette étude vise à 1) identifier les caractéristiques associées au contact/symptômes ou diagnostic de COVID-19 et 2) examiner l'association entre un contact/symptômes ou diagnostic de COVID-19 et les symptômes psychologiques. MéTHODES: Un total de 20 327 adultes ont participé à une enquête transversale populationnelle au Québec entre septembre 2020 et février 2021. À l'aide d'un questionnaire en ligne, des données ont été recueillies sur l'anxiété généralisée probable (GAD-7) et la dépression majeure probable (PHQ-9). Les évènements autodéclarés de 1) contact avec un cas ou de symptômes de COVID-19 et 2) diagnostics de COVID-19 furent examinés, ainsi que plusieurs facteurs sociodémographiques et liés à la pandémie. RéSULTATS: Les contacts, symptômes ou diagnostics de COVID-19 étaient plus fréquents chez les jeunes adultes, les travailleurs de la santé, les adultes vivant avec des enfants, et ceux rapportant plus de stigmatisation, pertes financières, stress quotidien ou un plus haut niveau de menace perçue. Des contacts ou symptômes de COVID-19 et un diagnostic de COVID-19 étaient associés à de la dépression majeure probable comparativement au groupe non affecté (RCa : 1,25, IC à 95% : 1,12-1,39 et RCa : 1,82, IC à 95% : 1,48-2,2, respectivement). Les pensées suicidaires et le retard psychomoteur étaient aussi plus étroitement associés à un diagnostic de COVID-19. CONCLUSION: Les résultats de cette étude soulignent le besoin d'améliorer nos connaissances et notre soutien pour les personnes souffrant de symptômes psychologiques suite à un diagnostic de COVID-19.


Subject(s)
COVID-19 , Anxiety/epidemiology , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Testing , Child , Cross-Sectional Studies , Depression , Humans , Quebec/epidemiology , SARS-CoV-2 , Self Report , Surveys and Questionnaires , Young Adult
9.
Can J Public Health ; 113(3): 385-393, 2022 06.
Article in English | MEDLINE | ID: covidwho-1776742

ABSTRACT

OBJECTIVES: We previously estimated the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies following the first pandemic wave at 2.23% in Québec, Canada. Following the much bigger second wave in fall 2020 and early 2021, we estimated the seroprevalence of anti-SARS-CoV-2 in Québec during the first months of 2021. METHODS: Blood samples from regular, asymptomatic (for ≥ 14 days) donors were collected between January 25, 2021 and March 11, 2021. Anti-SARS-CoV-2 seropositivity was assessed using an enzyme-linked immunosorbent assay that captures antibodies directed against the receptor binding domain of the SARS-CoV-2 spike (and hence cannot discriminate between infection- and vaccine-induced seropositivity). Seroprevalence estimates were adjusted for regional distribution, age, and sex. RESULTS: Samples from 7924 eligible donors were analyzed, including 620 (7.8%) vaccinated donors and 7046 (88.9%) unvaccinated donors (vaccination status unknown for 258 (3.3%) donors). Overall, median age was 51 years; 46.4% of donors were female. The adjusted seroprevalence was 10.5% (95% CI = 9.7-11.3) in the unvaccinated population and 14.7% (95% CI = 13.8-15.6) in the overall population. Seroprevalence gradually decreased with age and was higher among donors who self-identified as having a racial/ethnic background other than white, both in the overall and in the unvaccinated populations. CONCLUSION: The seroprevalence of SARS-CoV-2 antibodies significantly increased in Québec since spring 2020, with younger persons and ethnic minorities being disproportionately affected. When compared with the cumulative incidence rate reported by public health authorities (i.e., 3.3% as of March 11, 2021), these results suggest that a substantial proportion of infections remain undetected despite improvements in access to COVID-19 testing.


RéSUMé: OBJECTIFS: Lors d'une première étude, nous avons estimé la séroprévalence des anticorps contre le syndrome respiratoire aigu sévère coronavirus 2 (SRAS-CoV-2) après la première vague pandémique à 2,23 % au Québec, Canada. Cette seconde étude estime la séroprévalence de l'anti-SRAS-CoV-2 au Québec lors de la deuxième vague pandémique. MéTHODES: Des échantillons de donneurs de sang asymptomatiques (≥ 14 jours) ont été prélevés entre le 25 janvier et le 11 mars 2021. La séropositivité a été évaluée à l'aide d'un dosage immuno-enzymatique qui capture les anticorps dirigés contre la protéine Spike du récepteur de domaine de liaison du SARS-CoV-2 (et ne peut donc distinguer l'immunité induite par l'infection et la vaccination). La séroprévalence a été ajustée en fonction de l'âge et du sexe par région. RéSULTATS: Des échantillons de 7 924 donneurs ont été analysés, dont 620 (7,8 %) étaient vaccinés et 7 046 (88,9 %) étaient non vaccinés (statut vaccinal inconnu pour 258 (3,3 %) donneurs). Dans l'ensemble, l'âge médian était de 51 ans et 46,4 % des donneurs étaient des femmes. La séroprévalence ajustée était de 10,5 % (IC 95 % = 9,7 à 11,3) dans la population non vaccinée et de 14,7 % (IC 95 % = 13,8 à 15,6) dans la population globale. La séroprévalence diminuait progressivement avec l'âge et était plus élevée chez les donneurs d'origine ethnique autre que blanche. CONCLUSION: La séroprévalence anti-SRAS-CoV-2 a considérablement augmenté au Québec depuis le printemps 2020, les personnes plus jeunes et les minorités ethniques étant plus touchées. Comparés au taux d'incidence cumulatif signalé par la santé publique (c.-à-d. 3,3 % au 11 mars 2021), ces résultats suggèrent qu'une proportion importante d'infections reste non détectée.


Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Viral , Blood Donors , COVID-19/epidemiology , COVID-19 Testing , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Quebec/epidemiology , Seroepidemiologic Studies
10.
Front Public Health ; 10: 756037, 2022.
Article in English | MEDLINE | ID: covidwho-1775971

ABSTRACT

Introduction: The objective of this study was to characterize the combinations of demographic and socioeconomic characteristics associated to the unwillingness to receive the COVID-19 vaccines during the 2021 Quebec's vaccination campaign. Materials and Methods: In March-June 2021, we conducted an online survey of the participants of the CARTaGENE population-based cohort, composed of middle-aged and older adults. After comparing the vaccinated and unvaccinated participants, we investigated vaccine hesitancy among participants who were unvaccinated. For identifying homogeneous groups of individuals with respect to vaccine hesitancy, we used a machine learning approach based on a hybrid tree-based model. Results: Among the 6,105 participants of the vaccine cohort, 3,553 (58.2%) had at least one dose of COVID-19 vaccine. Among the 2,552 participants, 221 (8.7%) did not want to be vaccinated (91) or were uncertain (130). The median age for the unvaccinated participants was 59.3 years [IQR 54.7-63.9]. The optimal hybrid tree-based model identified seven groups. Individuals having a household income lower than $100,000 and being born outside of Canada had the highest rate of vaccine hesitancy (28% [95% CI 19.8-36.3]). For those born in Canada, the vaccine hesitancy rate among the individuals who have a household income below $50,000 before the pandemic or are Non-retired was of 12.1% [95% CI 8.7-15.5] and 10.6% [95% CI 7.6-13.7], respectively. For the participants with a high household income before the pandemic (more than $100,000) and a low level of education, those who experienced a loss of income during the pandemic had a high level of hesitancy (19.2% [8.5-29.9]) whereas others who did not experience a loss of income had a lower level of hesitancy (6.0% [2.8-9.2]). For the other groups, the level of hesitancy was low of around 3% (3.2% [95% CI 1.9-4.4] and 3.4% [95% CI 1.5-5.2]). Discussion: Public health initiatives to tackle vaccine hesitancy should take into account these socio-economic determinants and deliver personalized messages toward people having socio-economic difficulties and/or being part of socio-cultural minorities.


Subject(s)
COVID-19 Vaccines , COVID-19 , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Demography , Humans , Immunization Programs , Middle Aged , Patient Acceptance of Health Care , Quebec/epidemiology , Vaccination
11.
LGBT Health ; 9(3): 151-160, 2022 04.
Article in English | MEDLINE | ID: covidwho-1740730

ABSTRACT

Purpose: Sexual and gender minority (SGM) people are at increased risk for psychological distress compared with cisgender heterosexual people. Specific SGM subgroups include lesbian, gay, bisexual, gender diverse, and asexual people who each experience unique psychosocial challenges that can result in different mental health outcomes. The coronavirus disease 2019 (COVID-19) pandemic may have further exacerbated mental health disparities among these groups. The aim of this study was to compare lesbian, gay, bisexual, gender diverse, asexual, and cisgender heterosexual people's mental health and social support during the first 4 months of the COVID-19 crisis. Methods: This study used a cross-sectional online survey from March 26th, 2020 to July 7th, 2020 in Québec, Canada. A total of 2908 individuals (n = 304 SGM people, n = 2604 cisgender heterosexual people) completed questionnaires measuring perceived social support, perceived stress, symptoms of depression and anxiety, as well as loneliness. Results: SGM people presented worse health outcomes than cisgender heterosexual people on all questionnaires (p < 0.001). Post hoc analyses showed that particularly marginalized SGM subgroups, including bisexual and asexual people, reported the poorest mental health. Moderation analyses revealed that the buffering effect of social support on depressive symptoms was four times stronger among SGM people (ΔR2 = 0.041; p < 0.001) than among cisgender heterosexual people (ΔR2 = 0.010; p < 0.001). Conclusion: This study suggests that fostering social connectedness among SGM people may be especially beneficial in buffering against distress in the face of a crisis.


Subject(s)
COVID-19 , Sexual and Gender Minorities , Cross-Sectional Studies , Female , Humans , Mental Health , Quebec/epidemiology , Social Support
12.
CMAJ ; 194(9): E350-E360, 2022 03 07.
Article in French | MEDLINE | ID: covidwho-1731613

ABSTRACT

CONTEXTE: La pandémie de COVID-19 a affecté de manière disproportionnée les travailleurs de la santé. Nous avons voulu mesurer la séroprévalence du SRAS-CoV-2 chez les travailleurs de la santé dans les hôpitaux du Québec, au Canada, après la première vague de la pandémie, afin d'explorer les facteurs associés à la SRAS-CoV-2-séropositivité. MÉTHODES: Entre le 6 juillet et le 24 septembre 2020, nous avons recruté des travailleurs de la santé de 10 hôpitaux, dont 8 d'une région où l'incidence de la COVID-19 était élevée (région de Montréal) et 2 de régions du Québec où l'incidence était faible. Les travailleurs de la santé admissibles étaient des médecins, des infirmières, des préposées aux bénéficiaires et des préposés à l'entretien ménager travaillant dans 4 types d'unité de soins (urgences, soins intensifs, unité hospitalière COVID-19 et unité hospitalière non-COVID-19). Les participants ont répondu à un questionnaire et subi un dépistage sérologique du SRAS-CoV-2. Nous avons identifié les facteurs ayant un lien indépendant avec une séroprévalence plus élevée. RÉSULTATS: Parmi les 2056 travailleurs de la santé recrutés, 241 (11,7 %) se sont révélés SRAS-CoV-2-positifs. Parmi eux, 171 (71,0 %) avaient déjà reçu un diagnostic de COVID-19. La séroprévalence a varié d'un hôpital à l'autre, de 2,4 %­3,7 % dans les régions où l'incidence était faible, à 17,9 %­32,0 % dans les hôpitaux ayant connu des éclosions touchant 5 travailleurs de la santé ou plus. La séroprévalence plus élevée a été associée au fait de travailler dans un hôpital où des éclosions sont survenues (rapport de prévalence ajusté 4,16, intervalle de confiance [IC] à 95 % 2,63­6,57), au fait d'être infirmière ou auxiliaire (rapport de prévalence ajusté 1,34, IC à 95 % 1,03­1,74), préposée aux bénéficiaires (rapport de prévalence ajusté 1,49, IC à 95 % 1,12­1,97) et d'ethnicité noire ou hispanique (rapport de prévalence ajusté 1,41, IC à 95 % 1,13­1,76). La séroprévalence moindre a été associée au fait de travailler dans une unité de soins intensifs (rapport de prévalence ajusté 0,47, IC à 95 % 0,30­0,71) ou aux urgences (rapport de prévalence ajusté 0,61, IC à 95 % 0,39­0,98). INTERPRÉTATION: Les travailleurs de la santé des hôpitaux du Québec ont été exposés à un risque élevé d'infection par le SRAS-CoV-2, particulièrement lors des éclosions. Il faudra travailler à mieux comprendre la dynamique de la transmission du SRAS-CoV-2 dans les milieux de soins.


Subject(s)
Antibodies, Viral/analysis , COVID-19 Serological Testing/methods , COVID-19/epidemiology , Health Personnel/statistics & numerical data , Pandemics , SARS-CoV-2/immunology , Seroepidemiologic Studies , Adult , COVID-19/diagnosis , COVID-19/virology , Cross-Sectional Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Quebec/epidemiology , Retrospective Studies
13.
BMJ Open ; 12(3): e060295, 2022 03 07.
Article in English | MEDLINE | ID: covidwho-1731282

ABSTRACT

OBJECTIVES: To study the association between polypharmacy and the risk of hospitalisation and death in cases of COVID-19 in the population over the age of 65. DESIGN: Population-based cohort study. SETTING: Quebec Integrated Chronic Disease Surveillance System, composed of five medico-administrative databases, in the province of Quebec, Canada. PARTICIPANTS: 32 476 COVID-19 cases aged over 65 whose diagnosis was made between 23 February 2020 and 15 March 2021, and who were covered by the public drug insurance plan (thus excluding those living in long-term care). We counted the number of different medications they claimed between 1 April 2019 and 31 March 2020. OUTCOME MEASURES: Robust Poisson regression was used to calculate relative risk of hospitalisation and death associated with the use of multiple medications, adjusting for age, sex, chronic conditions, material and social deprivation and living environment. RESULTS: Of the 32 476 COVID-19 cases included, 10 350 (32%) were hospitalised and 4146 (13%) died. Compared with 0-4 medications, polypharmacy exposure was associated with increased hospitalisations, with relative risks ranging from 1.11 (95% CI 1.04 to 1.19) for those using 5-9 medications to 1.62 (95% CI 1.51 to 1.75) for those using 20+. Similarly, the risk of death increased with the number of medications, from 1.13 (95% CI 0.99 to 1.30) for those using (5-9 medications to 1.97 (95% CI 1.70 to 2.27) (20+). Increased risk was mainly observed in younger groups. CONCLUSIONS: Polypharmacy was significantly associated with the risk of hospitalisations and deaths related to COVID-19 in this cohort of older adults. Polypharmacy may represent a marker of vulnerability, especially for younger groups of older adults.


Subject(s)
COVID-19 , Polypharmacy , Aged , Cohort Studies , Hospitalization , Humans , Quebec/epidemiology , SARS-CoV-2
14.
Nurs Open ; 9(3): 1744-1756, 2022 05.
Article in English | MEDLINE | ID: covidwho-1707647

ABSTRACT

AIM: To describe the state of health of Quebec nursing staff during the pandemic according to their exposure to COVID-19, work-related characteristics and sociodemographic factors (gender, generational age group). State of health was captured essentially by assessing psychological distress, depression symptoms and fatigue. DESIGN AND METHODS: A large-scale cross-sectional study was conducted with 1,708 nurses and licenced practical nurses in Quebec (87% women, mean age of 41 ± 11 years). The survey included several questionnaires and validated health-related scales (psychological distress, depression symptoms and fatigue). The STROBE guidelines were followed in reporting the study's findings. RESULTS: Results showed that the prevalence of psychological distress and depression symptoms was moderate to severe. Women, generation Xers and Yers, nurses who cared for COVID-19 patients and those with a colleague who was infected with COVID-19 at work scored higher for fatigue, psychological distress and depression.


Subject(s)
COVID-19 , Nursing Staff , Psychological Distress , Adult , Cross-Sectional Studies , Depression/epidemiology , Depression/psychology , Fatigue/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Quebec/epidemiology , SARS-CoV-2
15.
BMC Prim Care ; 23(1): 32, 2022 02 21.
Article in English | MEDLINE | ID: covidwho-1700825

ABSTRACT

BACKGROUND: There was an increase in self-reported mental health needs during the COVID-19 pandemic in Canada, with research showing reduced access to mental health services in comparison to pre-pandemic levels. This paper explores 1) barriers and facilitating factors associated with mental health service delivery via primary care settings during the first two pandemic waves in Quebec, Canada, and 2) recommendations to addressing these barriers. METHODS: A qualitative descriptive study design was used. Semi-structured interviews with 20 participants (health managers, family physicians, mental health clinicians) were conducted and coded using a thematic analysis approach. RESULTS: Barriers and facilitating factors were organized according to Chaudoir et al. (2013)'s framework of structural, organizational, provider- and patient-related, as well as innovation (technological modalities for service delivery) categories. Barriers included relocation of mental health staff to non-mental health related COVID-19 tasks (structural); mental health service interruption (organizational); mental health staff on preventive/medical leave (provider); the pandemic's effect on consultations (i.e., perceptions of increased demand) (patients); and challenges with the use of technological modalities (innovation). Facilitating factors included reinforcements to mental health care teams (structural); perceptions of reductions in wait times for mental health evaluations during the second wave due to diminished FP referrals in the first wave, as well as supports (i.e., management, private sector, mental health trained staff) for mental health service delivery (organizational); staff's mental health consultation practices (provider); and advantages in increasing the use of technological modalities in practice (innovation). CONCLUSIONS: To our knowledge, this is the first study to explore barriers and facilitating factors to mental health service delivery during the pandemic in Quebec, Canada. Some barriers identified were caused by the pandemic, such as the relocation of staff to non-mental health services and mental health service interruption. Offering services virtually seemed to facilitate mental health service delivery only for certain population groups. Recommendations related to building and strengthening human and technological capacity during the pandemic can inform mental health practices and policies to improve mental health service delivery in primary care settings and access to mental health services via access points.


Subject(s)
COVID-19 , Mental Health Services , Canada/epidemiology , Humans , Pandemics , Quebec/epidemiology , SARS-CoV-2
16.
CMAJ Open ; 10(1): E74-E81, 2022.
Article in English | MEDLINE | ID: covidwho-1703594

ABSTRACT

BACKGROUND: During the first wave of the COVID-19 pandemic, a substantial number of Quebec hospitals were hit by hospital-acquired (HA) SARS-CoV-2 infections. Our objective was to assess whether mortality is higher in HA cases than in non-hospital-acquired (NHA) cases and determine the prevalence of HA-SARS-CoV-2 infection in our hospital. METHODS: This retrospective single-centre cohort study included all adults (≥ 18 yr) who had COVID-19, admitted to Hôpital Maisonneuve-Rosemont (Montréal, Canada) from Mar. 1 to June 30, 2020. We collected data on demographic characteristics, comorbidities, treatment, admission to the intensive care unit (ICU) and mechanical ventilation requirements from electronic health records. We adjudicated hospital acquisition based on the timing of symptom onset, and polymerase chain reaction testing for and exposures to SARS-CoV-2. To evaluate the association between HA-SARS-CoV-2 infection and in-hospital mortality, we computed a multivariable logistic regression analysis including known risk factors for death in patients with COVID-19 as covariates. RESULTS: Among 697 patients with SARS-CoV-2 infection, 253 (36.3%) were classified as HA. The mortality rate was higher in the HA group than in the NHA group (38.2% v. 26.4%, p = 0.001), while the rates of ICU admission (8.3% v. 19.1%, p = 0.001) and requirement for mechanical ventilation (3.6% v. 13.0%, p = 0.001) were lower. Multivariable logistic regression analysis showed that HA-SARS-CoV-2 infection in patients younger than 75 years is an independent risk factor for death (odds ratio 2.78, 95% confidence interval 1.44-5.38). INTERPRETATION: Our results show that HA-SARS-CoV-2 infection in younger patients was associated with higher mortality. Future studies need to evaluate relevant patient-centred long-term outcomes in this population.


Subject(s)
COVID-19/mortality , Iatrogenic Disease/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/therapy , COVID-19/virology , COVID-19 Nucleic Acid Testing , Female , Hospital Mortality , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Pandemics/statistics & numerical data , Quebec/epidemiology , RNA, Viral/isolation & purification , Respiration, Artificial/statistics & numerical data , Retrospective Studies , Risk Assessment , Risk Factors , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification , Treatment Outcome , Young Adult
17.
JAMA Netw Open ; 5(2): e2147042, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1680203

ABSTRACT

Importance: Given limited COVID-19 vaccine availability early in the pandemic, optimizing immunization strategies was of paramount importance. Ring vaccination has been used successfully to control transmission of other airborne respiratory viruses. Objective: To assess the association of a ring vaccination intervention on COVID-19 spread in the initial epicenter of SARS-CoV-2 Alpha variant transmission in Montreal, Canada. Design, Setting, and Participants: This cohort study compared COVID-19 daily disease risk in 3 population-based groups of neighborhoods in Montreal, Canada, defined by their intervention-specific vaccine coverage at the neighborhood level: the primary intervention group (500 or more vaccinated persons per 10 000 persons), secondary intervention group (95 to 499), and control group (0 to 50). The groups were compared within each of 3 time periods: before intervention (December 1, 2020, to March 16, 2021), during and immediately after intervention (March 17 to April 17, 2021), and 3 weeks after the intervention midpoint (April 18 to July 18, 2021). Data were analyzed between June 2021 and November 2021. Exposures: Vaccination targeted parents and teachers of children attending the 32 schools and 48 childcare centers in 2 adjacent neighborhoods with highest local transmission (case counts) of Alpha variant shortly after its introduction. Participants were invited to receive 1 dose of mRNA vaccine between March 22 and April 9, 2021 (before vaccine was available to these age groups). Main Outcomes and Measures: COVID-19 risk in 3 groups of neighborhoods based on intervention-specific vaccine coverage. Results: A total of 11 794 residents were immunized, with a mean (SD) age of 43 (8) years (range, 16-93 years); 5766 participants (48.9%) lived in a targeted neighborhood, and 9784 (83.0%) were parents. COVID-19 risk in the primary intervention group was significantly higher than in the control group before (unadjusted risk ratio [RR], 1.58; 95% CI 1.52-1.65) and during (RR, 1.63; 95% CI, 1.52-1.76) intervention, and reached a level similar to the other groups in the weeks following the intervention (RR, 1.03; 95% CI, 0.94-1.12). A similar trend was observed when restricting to SARS-CoV-2 variants and persons aged 30 to 59 years (before: RR, 1.72; 95% CI, 1.63-1.83 vs after: RR, 1.01; 95% CI, 0.88-1.17). Conclusions and Relevance: Our findings show that ring vaccination was associated with a reduction in COVID-19 risk in areas with high local transmission of Alpha variant shortly after its introduction. Ring vaccination may be considered as an adjunct to mass immunization to control transmission in specific areas, based on local epidemiology.


Subject(s)
COVID-19/drug therapy , COVID-19/transmission , Risk Assessment/methods , Vaccination/standards , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Child , Cohort Studies , Female , Humans , Male , Mass Vaccination/methods , Mass Vaccination/standards , Mass Vaccination/statistics & numerical data , Middle Aged , Odds Ratio , Population Surveillance/methods , Quebec/epidemiology , Risk Assessment/statistics & numerical data , SARS-CoV-2/drug effects , SARS-CoV-2/pathogenicity , Vaccination/methods , Vaccination/statistics & numerical data
18.
Psychoneuroendocrinology ; 138: 105645, 2022 04.
Article in English | MEDLINE | ID: covidwho-1671062

ABSTRACT

BACKGROUND: The COVID-19 pandemic has put chronic pressure on worldwide healthcare systems. While the literature regarding the prevalence of psychological distress and associated risk factors among healthcare workers facing COVID-19 has exploded, biological variables have been mostly overlooked. METHODS: 467 healthcare workers from Quebec, Canada, answered an electronic survey covering various risk factors and mental health outcomes three months after the onset of the COVID-19 pandemic. Of them, 372 (80%) provided a hair sample, providing a history of cortisol secretion for the three months preceding and following the pandemic's start. We used multivariable regression models and a receiver operating characteristic curve to study hair cortisol as a predictor of burnout and psychological health, together with individual, occupational, social, and organizational factors. RESULTS: As expected, hair cortisol levels increased after the start of the pandemic, with a median relative change of 29% (IQR = 3-59%, p < 0.0001). There was a significant association between burnout status and change in cortisol, with participants in the second quarter of change having lower odds of burnout. No association was found between cortisol change and post-traumatic stress disorder, anxiety, and depression symptoms. Adding cortisol to individual-occupational-socio-organizational factors noticeably enhanced our burnout logistic regression model's predictability. CONCLUSION: Change in hair cortisol levels predicted burnout at three months in health personnel at the onset of the COVID-19 pandemic. This non-invasive biological marker of the stress response could be used in further clinical or research initiatives to screen high-risk individuals to prevent and control burnout in health personnel facing an important stressor.


Subject(s)
Burnout, Professional , COVID-19 , Hair , Health Personnel , Hydrocortisone , Biomarkers/metabolism , Burnout, Professional/epidemiology , COVID-19/epidemiology , COVID-19/psychology , Hair/chemistry , Health Personnel/psychology , Humans , Hydrocortisone/metabolism , Pandemics , Quebec/epidemiology
20.
CMAJ ; 193(49): E1868-E1877, 2021 12 13.
Article in English | MEDLINE | ID: covidwho-1591952

ABSTRACT

BACKGROUND: The COVID-19 pandemic has disproportionately affected health care workers. We sought to estimate SARS-CoV-2 seroprevalence among hospital health care workers in Quebec, Canada, after the first wave of the pandemic and to explore factors associated with SARS-CoV-2 seropositivity. METHODS: Between July 6 and Sept. 24, 2020, we enrolled health care workers from 10 hospitals, including 8 from a region with a high incidence of COVID-19 (the Montréal area) and 2 from low-incidence regions of Quebec. Eligible health care workers were physicians, nurses, orderlies and cleaning staff working in 4 types of care units (emergency department, intensive care unit, COVID-19 inpatient unit and non-COVID-19 inpatient unit). Participants completed a questionnaire and underwent SARS-CoV-2 serology testing. We identified factors independently associated with higher seroprevalence. RESULTS: Among 2056 enrolled health care workers, 241 (11.7%) had positive SARS-CoV-2 serology. Of these, 171 (71.0%) had been previously diagnosed with COVID-19. Seroprevalence varied among hospitals, from 2.4% to 3.7% in low-incidence regions to 17.9% to 32.0% in hospitals with outbreaks involving 5 or more health care workers. Higher seroprevalence was associated with working in a hospital where outbreaks occurred (adjusted prevalence ratio 4.16, 95% confidence interval [CI] 2.63-6.57), being a nurse or nursing assistant (adjusted prevalence ratio 1.34, 95% CI 1.03-1.74) or an orderly (adjusted prevalence ratio 1.49, 95% CI 1.12-1.97), and Black or Hispanic ethnicity (adjusted prevalence ratio 1.41, 95% CI 1.13-1.76). Lower seroprevalence was associated with working in the intensive care unit (adjusted prevalence ratio 0.47, 95% CI 0.30-0.71) or the emergency department (adjusted prevalence ratio 0.61, 95% CI 0.39-0.98). INTERPRETATION: Health care workers in Quebec hospitals were at high risk of SARS-CoV-2 infection, particularly in outbreak settings. More work is needed to better understand SARS-CoV-2 transmission dynamics in health care settings.


Subject(s)
COVID-19/epidemiology , Occupational Diseases/epidemiology , SARS-CoV-2 , COVID-19/blood , COVID-19/etiology , Cross-Sectional Studies , Demography , Health Personnel , Hospitals , Humans , Incidence , Occupational Diseases/blood , Occupational Diseases/etiology , Pandemics , Quebec/epidemiology , Risk Factors , Seroepidemiologic Studies , Surveys and Questionnaires
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